Abstract
Purpose :
Semaglutide is a medication used for the treatment of type 2 diabetes. Rapid glycemic control and hemoglobin A1c and have been associated with worsening of DR in a preapproval cardiovascular outcomes study with Semaglutide. Paradoxical worsening of DR after a sudden drop in blood glucose is a well-documented phenomenon with other medications; however, for Semaglutide, the long-term effects of acute worsening of DR remain unclear. We hypothesize if worsening of DR occurs with Semaglutide in patients with type 2 diabetes (T2D) it is temporary and not associated with continued DR progression.
Methods :
Retrospective data analysis identified 4086 patients with T2D and DR by ICD-10 codes (E11.3XXX) in a Retina only practice from January to June 2020. The use of Semaglutide was found in 116 patients. Inclusion criteria included at least 1 year of Semaglutide and documentation of the level of non-proliferative (NPDR) and proliferative (PDR) retinopathy, visual acuity (VA), and Central Subfield Thickness (CST). 87 patients were included for descriptive analysis.
Results :
87 patients met the inclusion criteria; 36 (41.4%) Female; average age 62.4 years with a range (38-84); baseline level of DR range (10-85); 11.5% mild NPDR (level 10); 38.5% moderate NPDR (level 35-43); 14.4% severe NPDR (level 47-53); 35.6 % PDR (level 61-85). The level of retinopathy progressed over one year in 5.7% of eyes, improved in 8% of eyes, and remained stable in 86.2% of eyes. Over the course of one-year visual acuity remained unchanged in 72.4% of patients while 12.6% of patients lost > 2 lines of vision in at least one eye and 14.9% gained > 2 lines of vision in at least one eye. CST remained unchanged in 44.2%, increased by at least 10% in one eye of 25.6%, and decreased by at least 10% in one eye of 30.2% of patients. Intravitreal injections were required in at least one eye of 63.2% of patients with an average number of injections of 6.1 per patient.
Conclusions :
Semaglutide use was not associated with an increased risk of progression of DR, visual loss, or an increased number of intravitreal injections over a 12-month period of time. If confirmed by prospective clinical trials, these findings would offer reassurance the long-term use of Semaglutide does not lead to progression of DR and sight-threatening disease.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.